These drugs are not first line agents and should be reserved for the indications outlined.
NICE CG 126 (management of stable angina) advises that if the person cannot tolerate beta blockers and calcium channel blockers or both are contraindicated, monotherapy with one of the following drugs can be considered:
- long-acting nitrate
- ivabradine
- nicorandil (see below)
- ranolazine
The decision regarding which drug to use should be based on comorbidities, contraindications, the person’s preference and drug costs.
Nicorandil
Prescribing Notes
- Nicorandil should be reserved for the treatment of stable angina in patients where treatment with rate-limiting agents, nitrates or dihydropyridine CCBs have been ineffective; it has similar efficacy to other anti-anginal drugs in controlling symptoms but there is little evidence regarding its efficacy in combination with other anti-anginal drugs.
- Gastrointestinal ulcerations, skin and mucosal ulceration have been frequently reported with nicorandil. These are refractory to treatment and most only respond to withdrawal of nicorandil treatment. If ulcerations develop, nicorandil should be discontinued.